Optimal candidates for early colonoscopy in the management of acute lower gastrointestinal bleeding.

BACKGROUND AND AIM: Early colonoscopy has not shown any advantages over elective colonoscopy in reducing the risk of early rebleeding (≤ 30 days) after acute lower gastrointestinal bleeding (ALGIB). Considering the heterogeneity among patients with ALGIB, we sought to evaluate appropriate candidates for early colonoscopy. METHODS: A total of 592 patients with ALGIB were enrolled, and the clinical outcomes of early colonoscopy were investigated. Thereafter, the participants were divided into two groups: the recent bleeding group (n = 445), with hematochezia 0-6 h before hospital arrival, and non-recent bleeding group (n = 147). The clinical outcomes yielded by early colonoscopy were assessed in each group. RESULTS: The multivariate analysis including the entire population revealed that early colonoscopy (< 24 h) did not reduce the risk of early rebleeding (adjusted odds ratio [AOR], 0.88; 95% confidence interval [CI], 0.55-1.39). However, in the subgroup analysis, early colonoscopy independently reduced the risk of early rebleeding in the recent bleeding group (AOR, 0.56; 95% CI, 0.33-0.94). Moreover, a reduction in the need for radiological or surgical intervention (AOR, 0.34), transfusion (AOR, 0.62), and prolonged hospitalization (AOR, 0.42), as well as improvement in diagnostic yield (AOR, 1.78) and endoscopic treatment rates (AOR, 1.66), were observed. Early colonoscopy did not improve the outcomes of the non-recent bleeding group. CONCLUSIONS: Early colonoscopy is not required for all patients with ALGIB. However, it may be suitable for those with hematochezia 0-6 h before hospital arrival, as it reduces early rebleeding and improves clinical outcomes.

[Two rare cases of severe hyponatremia with consciousness disorder following bowel preparation and high fluid intake].

Symptomatic hyponatremia due to bowel preparation is extremely rare, but it can cause severe neurological symptoms and require hospitalization. We report our experience with two cases of symptomatic hyponatremia after bowel preparation. Our findings suggest that the cause of hyponatremia may be not only oral bowel cleansing agents but also high fluid intake. Adjusting the dose and pace of oral bowel cleansing agents and fluid intake;rehydration should be considered to prevent any recurrences.

Squamous Metaplasia of the Colon Following Severe COVID-19.

A 53-year-old man was admitted for respiratory failure due to severe acute respiratory syndrome caused by a severe acute respiratory syndrome coronavirus 2 infection. The patient required prolonged artificial ventilation and extracorporeal membrane oxygenation (ECMO) for respiratory support. Despite successful discontinuation of ECMO, the patient experienced profuse watery diarrhea (5-10 L/day). A colonoscopy revealed an inflamed surface without undulation that uniformly extended throughout the colon. Biopsy specimens revealed complete disappearance of existing crypts and replacement with squamous or transitional epithelium normally observed in the anal transitional zone mucosa, with granulation tissue proliferation in the lamina propria. Watery diarrhea persisted despite corticosteroid and infliximab administration. Although diarrhea due to atrophy of the surface and cryptic epithelium as an intestinal manifestation of coronavirus disease 2019 usually responds to corticosteroids, refractory diarrhea can be attributed to squamous metaplasia with complete disappearance of the surface and cryptic epithelium.

Food-Induced Duodenal Obstruction Successfully Reopened by Endoscopic Treatment.

Duodenal obstruction is a rare event that is unlikely to be treated endoscopically. Herein, we describe the case of a 75-year-old woman who presented with vomiting and was diagnosed with food-induced duodenal obstruction. Impacted food was fragmented and removed by double-balloon enteroscopy, and the duodenal tract was reopened without any adverse events. Follow-up capsule endoscopy was performed one month after treatment to determine the obstruction etiology and it revealed a remarkably delayed passage of the capsule through the duodenum and excessive amounts of floating food residue in the third portion of the duodenum. Obstruction recurrence was not observed six months after endoscopic treatment. In conclusion, in our case, endoscopic treatment of duodenal obstruction prevented the unnecessary performance of surgery, suggesting its clinical utility for this condition.

Organoruthenium(II) and (III) amidinates, (eta5-C5Me5)Ru(eta-amidinate) and (eta5-C5Me5)RuCl(eta-amidinate), as unique redox catalysts for the intramolecular Kharasch reactions: facile access to a pyrrolizidine alkaloid skeleton under mild conditions.

A novel organoruthenium(III) amidinate, (eta5-C5Me5)RuCl(eta-iPrN=C(Me)NiPr) (2), has been prepared by oxidation of organoruthenium amidinate, (eta5-C5Me5)Ru(eta-iPrN=C-(Me)NiPr) (1), by organic chlorides; both 1 and 2 are found to be good catalysts for atom-transfer cyclization of N-allyltrichloroacetamides which are useful for successful preparation of a pyrrolizidine alkaloid skeleton under mild conditions.

Molecular assembly of fullerene-conjugated phthalocyanine derivative on Au(111) at single molecular level.

Molecular adlayers of doubly C(60)-conjugated phthalocyanine derivatives ((C(60))(2)NiPc) were examined on bare and zinc(II) octaethylporphyrin (ZnOEP)- and coronene-modified Au(111) surfaces. Electrochemical scanning tunneling microscopy (EC-STM) has revealed the structure of the (C(60))(2)NiPc adlayer at single molecular level. The (C(60))(2)NiPc adlayer is strongly influenced by the underlying organic layers, i.e., a disordered, a packed structure of (C(60))(2)NiPc was found on a clean Au(111) surface because of the strong interaction between (C(60))(2)NiPc molecule and Au(111) substrate, whereas a single (C(60))(2)NiPc molecule was clearly distinguished both on ZnOEP and coronene adlayers at a low coverage of (C(60))(2)NiPc molecules. The obtained results in the present study suggest that the underlying organic adlayers play an important role in the formation process of the (C(60))(2)NiPc molecule adlayer.

Electroabsorption spectra of directly linked tribenzotetraazachlorin-fullerene conjugates having either electron donating or withdrawing substituents in a polymer film.

Electroabsorption spectra of electron donating butyloxy- (OBu) or electron withdrawing butylsulfonyl (SO(2)Bu)-substituted tribenzotetraazachlorin (TBTAC)-C(60) conjugates (1 and 2, respectively) have demonstrated that significant change of the molecular polarizability is associated with the photoexcitation of 1 in the lower energy region, while that in the higher energy region is comparable with the corresponding band of 2, although the pi-aromatic structures of 1 and 2 are identical to each other, being consistent with the previously reported result of the DFT calculations.

Metal effects on electronic structures of directly linked tribenzotetraazachlorin-fullerene conjugates.

Mixed condensation of 1,2-dicyanofullerene (1) and 4,5-dibutyloxyphthalonitrile (2a) in the presence of vanadium(III) chloride (VCl3) in quinoline forms the hexabutyloxy-substituted tribenzotetraazachlorin (TBTAC) - fullerene (C60) vanadyl complex (3). UV-vis absorption and magnetic circular dichroism (MCD) spectroscopy demonstrated that 3 shows two intense Q-band components, whereas the previously reported nickel complex possessing the identical peripheral substituents (4) shows one intense and two medium-intense bands in the 600-800 nm region, indicating that the electronic mixing states of 3 are different from those of the nickel complex (4). The metal effects on electronic structures of the conjugates were interpreted using density functional theory (DFT) calculations.

Tetraazachlorin-fullerene conjugates: on-off control of electronic communication enabled by push-pull substituents.

Novel tetraazachlorin (TAC)-fullerene (C60) conjugates (TAC-C60) and their analogues (TAiBC-C60 and TABC-C60 where TAiBC = tetraazaisobacteriochlorin and TABC = tetraazabacteriochlorin) have been synthesized by condensing 1,2-dicyanofullerene (1) and phthalonitrile derivatives (2) in the presence of nickel chloride in quinoline, and fully characterized using mass spectrometry and 1H and 13C NMR. By arranging the TAC and C60 units at the minimum distance, and taking also into account the molecular symmetry, the resultant conjugates show on-off electronic communication behavior, depending on the push-pull properties of the peripheral substituents in the TAC moiety. Consequently, the UV-vis absorption spectrum of the electron-releasing butyloxy-substituted TAC-C60 (3a) contains an unusual group of three absorption bands in the Q-band region (500-900 nm) as a result of a strong electronic communication between the two moieties. On the other hand, the absorption spectrum of the electron-withdrawing butylsulfonyl-substituted TAC-C60 (3b) comprises a typically normal TAC spectrum with markedly split two-peak Q-bands. A similar phenomenon is observed between alkoxy-substituted TAiBC-C60 (4a) and butylsulfonyl-substituted TAiBC-C60 (4b). This study reveals that the electron-donating or -withdrawing nature of the peripheral substituents on an azachlorin moiety has an important effect on the electronic structures of our novel azachlorin-C60 conjugates, although the linking carbon atoms are aliphatic sp3 carbon atoms which generally do not contribute to aromaticity. The electronic structures of the conjugates have been investigated in detail using spectroscopic and electrochemical techniques with the aid of DFT calculations.